The Effect of Body Mass Index on Blood Pressure Response

KÜ Tıp Fak Derg 2010; 12(1)
ISSN 1302-3314
Orijinal Makale
In vitro evaluation of the accuracy of
Two electronic apex locators in primary teeth
Aylin AKBAY OBA*, Ali ERDEMİR**, Merve ERKMEN*
*
**
Kirikkale University Faculty of Dentistry, Department of Pedodontics, Turkey
Kirikkale University Faculty of Dentistry, Department of Endodontics, Turkey
Abstract
Aim: The aim of the this study was to evaluate the accuracy of two electronic apex locators; Root ZX (Morita, Kyoto, Japan) and Propex
(Dentsply, Maillefer, Switzerland ) in primary teeth in vitro.
Methods: Twenty seven extracted human primary molars were selected for a total of 69 root canals. Root canal length was measured
visually with the placement of a K-file 0.5 mm short of the apical foramen or the apical resorption level. Then following the manufacturer’s
instructions the length was determined using two apex locators. Data were analysed statistically using one-way ANOVA and Multiple
Comparison.
Results: Root ZX and Propex showed similar values with the actual lengths. No statistical significance was found between the measurements
of both apex locators.
Conclusions: Root ZX and Propex electronic apex locators accurately determined the root canal lengths in primary teeth. These devices can
be recommended for use in primary teeth during root canal therapy.
Key Words: Agar diffusion, antibacterial, root canal sealer, primary teeth, Enterococcus faecalis.
Key words: Apical foramen, root canal, primary teeth
Özet
Amaç: Bu çalışmanın amacı, Root ZX (Morita, Kyoto, Japan) ve Propex (Dentsply, Maillefer, Switzerland) isimli iki farklı elektronik apeks
bulucunun doğruluğunun süt dişleri üzerinde in vitro olarak değerlendirilmesidir.
Materyal Metod: Çalışmada yirmi yedi adet süt molar dişte toplam 69 kök kanalı kullanılmıştır. Kök kanal uzunlukları K tipi eğe ile apikal
foramen ya da apikal rezorpsiyon seviyesinden 0.5 mm kısa olacak şekilde gözle ölçülerek kaydedilmiştir. Daha sonra üretici firmanın
talimatları doğrultusunda apeks bulucular kullanılarak kanal uzunlukları ölçülmüştür. Veriler istatistiksel olarak tek yönlü ANOVA ve çoklu
karşılaştırma testi kullanılarak analiz edilmiştir.
Bulgular: Root ZX ve Propex kullanılarak gerçek kanal uzunlukları ile benzer değerler belirlenmiştir. İki apeks bulucunun ölçüm değerleri
arasında istatistiksel olarak anlamlı bir fark bulunamamıştır.
Sonuç: Root ZX ve Propex elektronik apeks bulucuları, süt dişlerinin kök kanal boyu uzunluklarını doğru olarak tespit etmiştir. Bu
cihazların süt dişlerinin kök kanal tedavisinde kullanımı tavsiye edilebilir.
Anahtar kelimeler: Apikal foramen, kök kanalı, süt dişleri
Anahtar kelimeler: Apikal foramen, kök kanalı, süt dişleri
Introduction
Root canal treatment helps to maintain the
integrity of primary dentition until normal
exfoliation when their pulps become infected 1.
Especially in primary teeth2,3 root length
determination is a crucial factor for successful root
canal treatment2,4. Moreover, it is important to avoid
injury of the succedaneous teeth bud1.
In primary teeth, the ideal method used to
determine the root canal length is controversial1,5,6.
Traditionally, radiographs have been the principal
tool for determining primary root canal lengths7,8.
However, radiographs can only provide twodimensional image9,10. The accurate determination of
root canal length or even an estimation of the
dentinocemental junction cannot be achieved
radiographically because of anatomical variations,
interference of anatomical structures or errors in
projection11-15. Also, superimposition of permanent
successors over primary root apices may obscure
root canal length determination7. Furthermore,
radiographic assessment is difficult particularly in
cases where the physiological resorption in primary
teeth occurs on the root’s buccal or lingual aspects12.
In children, it is often very difficult to get intraoral
radiographs to measure the root canal length because
of poor cooperation and limited access to the
mouth1,16.
Recently,
electronic
methods
for
determining the root canal length in both permanent
and primary teeth have gained popularity amongst
dentists because of the hazards of radiation2,19,20, the
technical problems associated with radiographic
techniques2,19, and the avoiding overinstrumentation
beyond the root canal terminus14. However, there are
few studies about the use of electronic apex locators
in primary dentition1,17,21,22.
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KÜ Tıp Fak Derg 2010; 12(1)
ISSN 1302-3314
Orijinal Makale
The apex locator Root ZX (J Morita Corp.,
Kyoto, Japan), a third generation electronic device,
has reportedly been able to detect the narrowest
diameter of the root canal under both wet and dry
conditions, and several studies have indicated its
high level of reliability2,22. The apex locator ProPex
II (Dentsply, Maillefer, Switzerland ) is multifrequency design for wet or dry accuracy23. In the
previous literature, there is no data about the use of
Propex in primary teeth. In this study we compared
the accuracy of ProPex II and Root ZX electronic
apex locators in primary teeth.
Materials and Methods
Human primary molar teeth with and
without physiological apical resorption up to one
third of the root were selected for the study.
Preliminary radiographs were taken to evaluate the
root canal anatomy, identify the radiographic apex
and exclude teeth with calcification. Sixty nine root
canals of twenty seven primary molars (15
mandibular and 12 maxillary) were included the
study and all root canals were numbered.
The cusps of the teeth were flattened with a
diamond bur using a high-speed handpiece under
water irrigation to establish a level surface to serve
as a stable unequivocal
reference for all
measurements2. After standard endodontic access
cavities were prepared, the pulp tissues were
removed with barbed broaches and the canal orifices
were widened using Gates-Glidden drills. The root
canals were irrigated with 5.25% NaOCl and dried
with absorbent paper point. Then a K-file (the
diameter was chosen according to the canal size)
fitted with a rubber stop was passively introduced
into the root canals until the tip was just visible at
either the apical foramen or the apical resorption
level under a 30× stereomicroscope (NikonSMZ
800). The file length was recorded with a millimeter
scale to 0.5 mm precision and 0.5 mm was
subtracted from the measurement. The values were
registered for each root canal as the actual length.
The
electronic
root
canal
length
determination was undertaken using two apex
locators: Root ZX (J Morita Corp., Kyoto, Japan)
and Propex (Dentsply, Maillefer, Switzerland). The
roots of the teeth were embedded up to the
cementoenamel junction in freshly mixed alginate
(Zhermack). The K files chosen according the canal
size were inserted into the root canals. Both apex
locators were operated following the manufacturer’s
instructions. During electronic measurement, the
circuit was closed in invitro environment by
inserting the labial clip of the corresponding locater
into the alginate and attaching the file holder to the
file. Root ZX measurements were accomplished
until the signal on display flashed ‘0.5 bar’ and
Propex measurements were registered when the
signal showed 0.5 mm to the apex. The electronic
measurements were recorded for further comparison
with those obtained by direct determination of the
root canal length.
Statistical evaluation was carried out using
one way ANOVA and Multiple Comparison test.
Results
The results are presented in Table 1. No
statistical significance was found between
measurements of actual lengths and electronic apex
locators. Both electronic devices showed similar
values with the actual lengths. Multiple comparisons
were not displayed any statistical significant
difference. (p>0.05)
Discussion
An accurate determination of the working length
contributes to a safe and effective instrumentation of
the root canals11,15,24. However, traditional
radiographic method to measure root canal length is
difficult in primary dentition11, because various
degrees of physiological root resorption in primary
teeth are unique and there is a tendency for primary
apices to be variable and dynamic and they have
less traditional orifices7. Electronic root length
determination may be helpful in overcoming the
shortcomings of the radiographic method1. In this
study radiographic evaluation were not included,
because the main purpose was to evaluate the
accuracy of two different electronic devices and to
compare their results with actual canal lengths1.
In this study, no statistical significant differences
were found between actual lengths and electronic
measurements. Also, there was no statistically
significant difference between Root ZX and Propex
measurements.
Visually determined length 69
11,97
standard
deviation
1,98
Root ZX
69
11,89
1,85
8,00
16,00
Propex
69
11,91
1,71
9,00
16,00
n
minimum
maximum
mean
8,00
16,50
Table 1. Mean, standard deviation and minimum-maximum value obtained by each technique
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KÜ Tıp Fak Derg 2010; 12(1)
ISSN 1302-3314
Orijinal Makale
Katz et al.20 first reported the use of an
apex locator in the primary dentition in 1996. Root
canal lengths determined by Root ZX were similar
to the actual canal length, and they recommended
the use of Root ZX in primary teeth.
Ghaemmaghami et al.7 tested Root ZX in their
study to compare in vivo and in vitro measurements
of root canal lengths in primary teeth, and reported
that Root ZX was able to locate the apex within
clinically acceptable range. The study of Tosun et
al.2 evaluated the accuracy of Root ZX and Tri
Auto ZX in primary teeth and demonstrated that
both apex locators used in the study could
accurately determine the root canal length in
primary teeth. Also in their study Root ZX was not
affected by the presence of root resorption.
Angwarawong & Panitvisai25 reported that the
accuracy of the Root ZX was high within ±0.5 mm
of the apical foramen. According to the result of
their in vitro study, they supported the use of
electronic apex locators to determine root length in
primary teeth. Kielbassa et al.21 tested Root ZX
clinically in primary teeth and after extraction they
compared the results to the actual lengths. They
reported that the performance of Root ZX seemed
to be satisfactory and suggested this electronic
device for clinical implementation of endodontics
in primary dentition. The findings of the studies
above2,7,20,21,25 agree with our results.
Bodur et al.1 evaluated in vitro the
accuracy of Root ZX and Endex apex locators in
primary teeth with or without root resorption. They
found statistically significant difference between
canal lengths obtained by the electronic apex
locators and actual lengths, and concluded that both
apex locators did not provide reliable data in
primary teeth with or without root resorption. Our
study results were not in accordance with the
findings of Bodur et al.1, as in our study the
differences between the actual lengths and
electronic measurements were not significant. This
could be explained by using together primary teeth
with or without root resorption in our study.
In the previous literature, there is no data
about the use of Propex in primary teeth. But in a
previous study26 which evaluated the accuracy of
Root ZX and ProPex apex locators in permanent
teeth, the percentage of measurements within ±0.5
mm of the actual lengths was 97.37% for the Root
ZX and 100% for the ProPex. Krajczár et al.27
compared working length determination by Propex
and radiographic method in permanent teeth. They
reported that there was no significant difference in
the measuring accuracy between the two methods.
According to the results of our study, Propex
electronic apex locator showed similar values with
the actual lengths in primary teeth.
The results of the present study showed
that Propex and Root ZX apex locators accurately
determined the root canal lengths in primary teeth.
Both electronic apex locators can be recommended
for use in primary root canal treatment, however,
further in vivo and in vitro evaluations of the
electronic apex locator in primary teeth should be
carried out.
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Coresponding author:
Aylin Akbay Oba
Kırıkkale Üniversitesi
Diş Hekimliği Fakültesi, Pedodonti AD
Mimar Sinan cad. No: 25
Kırıkkale, Türkiye
Business Tel: +90 318 224 49 27
Fax: +90 318 224 69 07
E-mail: [email protected]
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